Implementation and evaluation of a clinical pathway for non-invasive ventilation in critical care : a person-centred practice development approach

Abstract

Introduction: Non-invasive ventilation (NIV) is an alternative method for providing safe mechanical ventilatory assistance to adult patients presenting with acute respiratory failure. Internationally the utilisation of NIV has increased by 400% during the past decade. The clinical pathway for NIV was collaboratively developed by the multidisciplinary team in the critical care unit in 2012, but implementation into practice did not realise as anticipated. As the burden of chronic disease rises in South Africa, the healthcare system is under pressure to provide evidence-based and costeffective care to more patients. Avoiding endotracheal intubation reduces the patient’s risk of complications which lengthens the hospitalisation period and the cost of hospitalisation. The utilisation of clinical pathways in the South African context is limited. Aim: The overall aim of the study was implementation and evaluation of the outcomes of a person-centred clinical pathway for non-invasive ventilation in the critical care unit. Research methodology: Mixed method design through a personcentred practice development approach utilising emancipatory action research. Several data collection methods are used throughout the phases of the study. A critical realist worldview was held which incorporated the principles of a person-centred approach through collaboration, inclusion and participation. The study was conducted in three interdependent and interrelated phases. During Phase 1, the culture of the critical care units was assessed using a validated 37-item questionnaire to establish the perceptions of the critical care nurses related to evidence implementation. A total of twenty-three registered nurses participated. Additionally, the content of the clinical pathway was adapted following a rigorous literature review in collaboration with the internal facilitators and validated via a Delphi with critical care experts. Phase 2 was dedicated to the collaborative development of an implementation strategy for the implementation of the clinical pathway in the critical care unit. During Phase 3, the outcomes of the implementation of the clinical pathway for NIV was evaluated. Findings: The collaborative utilisation of a person-centred practice development approach for the implementation and evaluation of the clinical pathway for NIV, aided the researcher in identifying moral injury amongst critical care nurses, which inhibits the implementation of research evidence into practice.